African Descent and Glaucoma Evaluation Study (ADAGES) II: To identify what ocular and systemic factors account for the differences in the occurrence of vision loss and structural damage and the more rapid rate of progression found for individuals of African Descent (AD) compared to those of European Descent (ED) and to account for these differences when developing algorithms for predicting progression. The specific aims are 1) To quantify differences in progressive loss of visual function and structural damage between AD and ED patients with glaucoma, 2) To quantify differences in the rate of progressive visual loss and structural damage between AD and ED patients with glaucoma, and most importantly, 3) To combine information from structural imaging, visual function testing, clinical information and risk factors to develop and validate a multivariate model of improve detection and prediction of progressive glaucomatous damage. Design: A prospective, multi-center observational cohort study to obtain the additional follow-up needed to meet the project's objective. Participants are 618 AD and ED participants with glaucoma who were part of the cohort for ADAGES I, which focused on identifying differences due to ancestry that are important for diagnosing glaucoma, documenting stage of disease, and understanding the relationship among retinal structure and visual function. Data from an additional 323 ED participants is available from another the Diagnostic Innovations in Glaucoma Study (DIGS). Demographic variables, ophthalmological examination including stereophotographs, ocular, systemic, and other risk factors will be documented. Visual function with standard perimetry and optic nerve structure with the Heidelberg Retina Tomograph will be assessed at six-month intervals. Impact: Glaucoma, the leading cause of blindness in African Americans, is four to five times more likely to occur and to progress to severe visual impairment in persons of AD compared to persons of ED. Significant differences were found in a number of clinical and test findings between persons of AD compared to ED in ADAGES I. The additional longitudinal data from ADAGES II will provide critical longitudinal data to develop and validate multivariate prediction models of glaucomatous progression with input from quantitative optic nerve and retinal imaging and visual functional testing. ADAGES II will provide clinicians with critical information on the risk of progressing glaucoma in individual patients, information that can substantially improve the effectiveness of individualized treatment for this potentially blinding disease. PUBLIC HEALTH RELEVANCE: African Descent and Glaucoma Evaluation Study (ADAGES) II: Glaucoma is four to five times more likely to occur in persons of African descent, up to fifteen times more likely to cause meaningful visual impairment in this group compared to those of European descent and the leading cause of blindness in African Americans. ADAGES II will develop models to predict which individuals are most at risk for progression of glaucoma using knowledge gained about the factors associated with change in visual function and retinal structure, including ancestry, stage of disease, and rate of change. This will provide clinicians with critical information currently not known or well understood information that will substantially improve the effectiveness of individualized treatment for this potentially blinding disease.